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GALL BLADDER DOUBLE-DIVERTICUALE:
A CASE REPORT
‫الرتج‬ ‫مزدوجة‬ ‫المرارة‬
:
‫حالة‬ ‫تقرير‬
DR. MOHAMADAL-GAILANI MS, FRCS ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
CONSULTANT SURGEON
CHIEF OF SURGERY
AL HAMMADI HOSPITAL ‫الحمادي‬ ‫مستشفى‬
RIYADH ‫الرياض‬
KSA ‫السعودية‬ ‫العربية‬ ‫المملكة‬
• During laparoscopic cholecystectomy it is estimated that congenital
gallbladder malformations are diagnosed in 1% of the cases
• Congenital diverticula of the gall bladder are considered one of the
rarest congenital anomalies of the gallbladder.
• We present a case of double diverticulae of the gallbladder
encountered during a routine elective laparoscopic cholecystectomy
for cholelithiasis.
FIFETY NINE-YEAR-OLD SAUDI FEMALE
• OPD APRIL 2024: FOURYEAR HISTORY OF BILIARY COLIC
• OTHERWISE, FIT
• US: “DUPLICATED” GALLBLADDER COMPOSED OF 2 POUCHESTHE
SMALLER ONE HARBORS MULTIPLETINY ECHOGENIC SHADOWING STONES
(2-3MM) ANDTHE LARGER ONE HARBORS SOLITARY STONE 11MM. NORMAL
CALIBER CBD
• COUNSELLED FOR LAPAROSCOPIC CHOLECYSTECTOMY
• FINDINGS:
• CHRONIC CHOLECYSTITIS
• NO OBVIOUS “DUPLICATED” GALLBLADDER!
• GALLBLADDER NOTEDTO BE PARTLY BURRIED UNDERTHE LIVER
ON BOTH SIDES JUST PROXIMALTOTHE CYSTIC DUCT.
• PROCEDURE:
• FUNDUS-FIRST GALLBLADDER MOBILIZATION
• BLUNT DISSECTION OFTHE BURRIED PARTS
• LARGE BILATERAL DIVERTICULAE (POUCHES) REVEALED
LAPAROSCOPIC CHOLECYSTECTOMY
CYSTIC ARTERY
STUMP
BODY GALL
BLADDER
LONG CYSTIC
DUCT
DIVERTICULAE
RIGHT & LEFT
DIVERTICULAE
‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
DOUBLE-DIVERTICULUM GALLBLADDER:
DIVERTICULAE
CYSTIC DUCT
STUMP
FUNDUS &
BODY GALL
BLADDER
• A GALLBLADDER ASSOCIATED WITH ATRUE DIVERTICULUM IS
UNCOMMONLY FOUNDTO BE BURIED INTHE LIVER, LEADINGTO
SURGICAL DIFFICULTIES IN IDENTIFYING ANATOMY DURING
CHOLECYSTECTOMY.
• BACKGROUND KNOWLEDGE OFTHE EXPECTED ANOMALIES IS
ESSENTIAL IN GUIDINGTHE SURGEON SAFELYTHROUGHTHE
OPERATION OF LAPAROSCOPIC CHOLECYSTECTOMY
• THE GOAL ISTO AVOID POTENTIAL BILE DUCT INJURY WITH ITS
SERIOUS SEQUALAE.
• BE READYTO EXPECT CONGENITAL ANOMALIES OFTHE
GALLBLADDER!
• MORE IMPORTANTLY, BE FAMILIARWITH ALLTYPES OF EXPECTED
GALLBLADDERCONGENITAL ANOMALIES, INCLUDING DIVERTICULAE!
• DURING LAPAROSCOPIC CHOLECYSTECTOMY:
• ALWAYS EXERCISE SURGICAL PRUDENCE.
• LIMITTHE USE OF ELECTROCOAGULATION.
• ENSURETHAT NO STRUCTURES ARE DIVIDED UNTILA CLEAR PICTURE
OFTHE BILE DUCTS AND BLOODVESSELS IS OBTAINEDWITHIN
CALOT’STRIANGLE.
• SAFETY IN SURGERY! GOOD LUCK!
‫الرتج‬ ‫مزدوجة‬ ‫المرارة‬
:
‫تقرير‬
‫حالة‬
‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
‫العامة‬ ‫الجراحة‬ ‫استشاري‬
‫الجراحة‬ ‫قسم‬ ‫رئيس‬
‫الحمادي‬ ‫مستشفى‬
‫الرياض‬
,
‫السعودية‬ ‫العربية‬ ‫المملكة‬
DR. MOHAMAD AL-GAILANI MS, FRCS

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Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالة

  • 1. GALL BLADDER DOUBLE-DIVERTICUALE: A CASE REPORT ‫الرتج‬ ‫مزدوجة‬ ‫المرارة‬ : ‫حالة‬ ‫تقرير‬ DR. MOHAMADAL-GAILANI MS, FRCS ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬ CONSULTANT SURGEON CHIEF OF SURGERY AL HAMMADI HOSPITAL ‫الحمادي‬ ‫مستشفى‬ RIYADH ‫الرياض‬ KSA ‫السعودية‬ ‫العربية‬ ‫المملكة‬
  • 2. • During laparoscopic cholecystectomy it is estimated that congenital gallbladder malformations are diagnosed in 1% of the cases • Congenital diverticula of the gall bladder are considered one of the rarest congenital anomalies of the gallbladder. • We present a case of double diverticulae of the gallbladder encountered during a routine elective laparoscopic cholecystectomy for cholelithiasis.
  • 3. FIFETY NINE-YEAR-OLD SAUDI FEMALE • OPD APRIL 2024: FOURYEAR HISTORY OF BILIARY COLIC • OTHERWISE, FIT • US: “DUPLICATED” GALLBLADDER COMPOSED OF 2 POUCHESTHE SMALLER ONE HARBORS MULTIPLETINY ECHOGENIC SHADOWING STONES (2-3MM) ANDTHE LARGER ONE HARBORS SOLITARY STONE 11MM. NORMAL CALIBER CBD • COUNSELLED FOR LAPAROSCOPIC CHOLECYSTECTOMY
  • 4. • FINDINGS: • CHRONIC CHOLECYSTITIS • NO OBVIOUS “DUPLICATED” GALLBLADDER! • GALLBLADDER NOTEDTO BE PARTLY BURRIED UNDERTHE LIVER ON BOTH SIDES JUST PROXIMALTOTHE CYSTIC DUCT. • PROCEDURE: • FUNDUS-FIRST GALLBLADDER MOBILIZATION • BLUNT DISSECTION OFTHE BURRIED PARTS • LARGE BILATERAL DIVERTICULAE (POUCHES) REVEALED
  • 5. LAPAROSCOPIC CHOLECYSTECTOMY CYSTIC ARTERY STUMP BODY GALL BLADDER LONG CYSTIC DUCT DIVERTICULAE RIGHT & LEFT DIVERTICULAE ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
  • 7. • A GALLBLADDER ASSOCIATED WITH ATRUE DIVERTICULUM IS UNCOMMONLY FOUNDTO BE BURIED INTHE LIVER, LEADINGTO SURGICAL DIFFICULTIES IN IDENTIFYING ANATOMY DURING CHOLECYSTECTOMY. • BACKGROUND KNOWLEDGE OFTHE EXPECTED ANOMALIES IS ESSENTIAL IN GUIDINGTHE SURGEON SAFELYTHROUGHTHE OPERATION OF LAPAROSCOPIC CHOLECYSTECTOMY • THE GOAL ISTO AVOID POTENTIAL BILE DUCT INJURY WITH ITS SERIOUS SEQUALAE.
  • 8. • BE READYTO EXPECT CONGENITAL ANOMALIES OFTHE GALLBLADDER! • MORE IMPORTANTLY, BE FAMILIARWITH ALLTYPES OF EXPECTED GALLBLADDERCONGENITAL ANOMALIES, INCLUDING DIVERTICULAE! • DURING LAPAROSCOPIC CHOLECYSTECTOMY: • ALWAYS EXERCISE SURGICAL PRUDENCE. • LIMITTHE USE OF ELECTROCOAGULATION. • ENSURETHAT NO STRUCTURES ARE DIVIDED UNTILA CLEAR PICTURE OFTHE BILE DUCTS AND BLOODVESSELS IS OBTAINEDWITHIN CALOT’STRIANGLE. • SAFETY IN SURGERY! GOOD LUCK!
  • 9. ‫الرتج‬ ‫مزدوجة‬ ‫المرارة‬ : ‫تقرير‬ ‫حالة‬ ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬ ‫العامة‬ ‫الجراحة‬ ‫استشاري‬ ‫الجراحة‬ ‫قسم‬ ‫رئيس‬ ‫الحمادي‬ ‫مستشفى‬ ‫الرياض‬ , ‫السعودية‬ ‫العربية‬ ‫المملكة‬ DR. MOHAMAD AL-GAILANI MS, FRCS